Extended prostate biopsy scheme improves reliability of Gleason grading: Implications for radiotherapy patients
Extended prostate biopsy scheme improves reliability of Gleason grading: Implications for radiotherapy patients
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DOI：
10.1016/j.ijrobp.2003.10.014
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发表时间：
2004-06-01
影响因子：
7
通讯作者：
Presti, JC
中科院分区：
文献类型：
--
作者：
King, CR;McNeal, JE;Presti, JC
背景：对于六分式前列腺活检，潜在的病理Gleason分级更高的几率高达1/3。对于选择放射治疗治疗局限性前列腺癌的患者的治疗建议和管理(例如，是否有资格接受近距离放射治疗、外照射雄激素抑制治疗、选择性盆腔放射治疗)，对潜在分级的了解可能已经显著改变。这项研究检验了在接受扩展10核心活检方案的患者中活检与匹配的根治性前列腺癌Gleason分级之间的一致性模式，以评估其可靠性。方法和材料：从2000年年中到2003年年中，78名患者在本机构连续接受了扩展10核心周边区活检方案(六核外加两次侧方中段和两次侧基活检)和随后的根治性前列腺癌切除术。没有患者接受雄激素抑制。所有组织学分级均由一位病理学家(J.E.M.)进行。针刺活检的特征是定位、阳性核心内肿瘤的线性受累和阳性核心的总数。根治性前列腺癌标本以3 mm的间隔进行阶梯式切片，并表征总的癌体积和各Gleason分级的百分比。可用的临床参数包括直肠指诊、术前PSA和超声前列腺体积。活检的“临床显著”升级被定义为：(1)活检Gleason评分(BGS)6分至病理GS(PGS)7或更高；(2)BGS 3+4至PGS 4+3或更高；(3)BGS 7至PGS 8或更高。结果：62%的六分活检方案(SB)患者的Gleason评分与前列腺癌手术的Gleason评分完全匹配，25%的SB评分提高1分以上，13%的SB评分下降1分以上。这些等级不符率与已发表的六分仪系列相当。使用扩展活检方案(EB)的准确率为63%(与SB相比p=0.61)，升级为13%(与SB相比p=0.045)，降级为24%(p=0.06与SB相比)。与EB组的23.1%相比，SB组有38.1%的患者出现了这里定义的“临床显著”的升级(p=0.039)。对于BGS为6分的患者，66.7%的SB患者和36.8%的EB患者的临床显著升级(p=0.068)。原发性Gleason分级从3级升至4/5级，SB组为41.8%，EB组为25.5%(p=0.078)。经Logistic回归分析，未发现临床因素(T分期、PSA、前列腺体积、阳性核心百分比、肿瘤的线性范围)可以预测活检的临床显著升级。结论：扩展10核心活检方案在预测前列腺癌潜在病理Gleason评分方面显著优于六点活检。特别是，在揭示潜在的高级别成分的存在方面，它优于六分仪活组织检查。这种改善对最终选择放射治疗的患者的潜在临床影响表明，延长活检计划应该成为护理的标准。尽管如此，即使有了这样的改善，潜在评级将会更高的可能性仍高达五分之一。(C)2004年爱思唯尔公司。
Background: With sextant prostate biopsies, there is up to a 1-in-3 chance that the underlying pathologic Gleason grade is higher. Knowledge of the underlying grade might have significantly altered the therapeutic recommendations and management for patients electing radiotherapy for localized prostate cancer (e.g., eligibility for brachytherapy, androgen suppression with external beam radiotherapy, elective pelvic radiotherapy). This study examines the concordance patterns between biopsy and matched radical prostatectomy Gleason grade among patients undergoing an extended 10-core biopsy scheme to assess its reliability compared to sextant biopsies.Methods and Materials: Seventy-eight consecutive patients underwent an extended 10-core peripheral zone biopsy scheme (sextant plus two lateral mid and two lateral base biopsies) and subsequent radical prostatectomy at this institution between mid-2000 and mid-2003. No patient received androgen suppression. All histologic grading were made by a single pathologist (J.E.M.). Needle biopsies were characterized for location, linear involvement of cancer within positive cores, and total number of positive cores. Radical prostatectomy specimens were step-sectioned at 3-mm intervals and were characterized for total cancer volume and percentage of each Gleason grade present. Clinical parameters available included digital rectal exam, preoperative PSA, and ultrasound prostate volume. A "clinically significant" upgrading of the biopsy was defined as any of the following: (1) a biopsy Gleason score (bGS) of 6 to a pathologic GS (pGS) of 7 or higher, (2) a bGS 3 + 4 to a pGS of 4 + 3 or higher, and (3) a bGS of 7 to a pGS of 8 or higher. Statistical analyses were performed on the patterns Gleason score concordance between biopsies and matched radical prostatectomies.Results: An exact Gleason score match between biopsy and prostatectomy was observed in 62% of patients using the sextant biopsy scheme (SB), an upgrading of 1 or more grade points was seen in 25% and a downgrading of 1 or more points in 13% for SB. These rates of grade discordance are comparable to those of published sextant series. An exact match using the extended biopsy scheme (EB) was 63% (p = 0.61 compared with SB), whereas upgrading was 13% (p = 0.045 compared with SB) and downgrading was 24% (p = 0.06 compared with SB). A "clinically significant" upgrading as defined here was present in 38.1% of the SB group compared with 23.1% of the EB group (p = 0.039). For patients with bGS of 6, a clinically significant upgrading occurred in 66.7% with SB and in 36.8% with EB (p = 0.068). Upgrading of the primary Gleason grade from 3 to 4/5 was seen in 41.8% for the SB and in 25.5% for the EB group (p = 0.078). No clinical factors (T-stage, PSA, prostate volume, % positive cores, linear extent of cancer) were found to predict for a clinically significant upgrading of biopsies on logistic regression analysis.Conclusions: The extended 10-core biopsy scheme significantly improves on sextant biopsies in predicting the underlying pathologic Gleason score for prostate cancer. In particular, it is superior to sextant biopsies in revealing the presence of an underlying high-grade component. The potential clinical impact this improvement has for patients ultimately selecting radiotherapy suggests that an extended biopsy scheme should become the standard of care. Nevertheless, even with this improvement, there still remains up to a 1-in-5 chance that the underlying grade will be higher. (C) 2004 Elsevier Inc.